scribblings of a reporter

Private hospitals fear no one

Last year (2005) Saad Hammadi exposed that Dhaka’s Golden Hospital was running without a license. One year later he returns to the hospital and it has expanded its operations, still without a license, and riddled with rampant irregularities as is the case with most private clinics

On August 14 last year Zamadiul Hoque’s elder brother fell off his bike and broke his leg. At first admitted to the Narsingdi Sadar Hospital he was later transferred to the National Institute for Traumatology and Orthopaedic Rehabilitation, better known as the Pangu Hospitalat Agargaon.

‘Some people, claiming to be hospital staff at the Pangu, advised me to transfer my brother to a private hospital saying that I would not receive any emergency treatment over here,’ says Zamadiul.

‘On their advice I transferred him to theGoldenHospitalin Shyamoli.’

What ensued was a horrendous experience for Zamadiul, his brother and their entire family.

‘The hospital gave my brother wrong treatment and gave him a bad infection on his injured leg. Then, they overcharged us.’

‘There was not a single specialist in the hospital and yet they performed on his leg.’

Zamadiul’s agonies did not end there.

‘We later transferred him to another clinic at Kamlapur on advice of some other people. This time, his infection was further aggravated.’

Zamadiul’s brother may have gotten away with an infection but not all patients, lured into these unauthorised clinics and hospitals which have mushroomed in the city are that lucky. Allegations of gouging out eyes of patients after wrong diagnosis, of fake doctors and medical staff, organ theft, exaggerated prescriptions to benefit pharmacists, performing a few operations at one go, outrageous wrong treatment, negligence, sub-standard facilities, poor sanitation are some of the things these institutions, mostly operating without a license, are accused of.

Alongside, many doctors and government hospital staff are accused of conniving with these institutions and luring financial favours. Meanwhile, the health ministry is oblivious to their presence as the degree of their malpractice mounts with each passing day.

Over the years the healthcare business has mushroomed in such a way that there are at least 359 private hospitals and clinics in Dhaka city alone. However, the figure represents only the registered hospitals and clinics in the city and there are numerous other illegal and substandard hospitals operating in the capital and throughout the country, which will push the unofficial figure much higher.

Most of these new hospitals operate without any regulations exposing patients to trauma, disease, and death. The health ministry, meanwhile, does not shoulder its obligation to check the irregularities in these places. Cases of wrongful death are hardly discovered, investigated or kept a record of. Sheltered by the weak and inadequate laws, many illegal hospitals are doing brisk business.

Moreover, the brokers’ intervention in the business has helped the substandard and illegal hospitals to get patients from the government hospitals. The unending shortage of resources at the government hospitals allows brokers to easily exploit the patients.

Ninety-year-old Afdal Ahmed suffered a haemorrhage after breaking his thigh joint. When he was taken to thePanguHospital, the doctor told his grandson, Rafiqul Hassan, that an operation would only be possible after 15 days because of a packed schedule. He recommended Rafiqul go to a nearby private clinic if he wanted prompt treatment.

‘The doctor advised to go to this certain hospital where he would guarantee the best treatment. He told us to be careful because the Pangu was swarming with brokers and to trust his advise,’ says Rafiqul.

‘We later discovered that the hospital he was speaking of was infamous for wrong treatment and shady deals and that our doctor was a middleman himself,’ he says.

Patients seeking treatment from government hospitals like theSuhrawardyHospitalandPanguHospitalare regularly hoodwinked and persuaded by a section of doctors, ward boys and hospital staff, who are in connivance with the brokers. The patients are shifted to these hospitals in exchange of commissions.

‘For each patient diverted to these unauthorised hospitals, the brokers earn a commission ranging between 10 to 20 per cent of the contract,’ says one staff at theDhakaMedicalCollegeand Hospital. A network has been established by these brokers to resist any action by the government or law enforcement agencies.

Meanwhile, the government hospital administration finds them helpless against such malpractices.

‘We have to cater to emergency patients all the time and our operation theatres remain busy round the clock,’ says Prof Siraj-Ul-Islam, director of the National Institute for Traumatology and Orthopaedic Rehabilitation, ‘the hospital cannot accommodate all the patients at the same time, and this is where the brokers seize the opportunity.’

Investigation reveals that the unholy nexus of doctors and brokers has existed for over fifteen years.

Many of these hospitals are sheltered by criminal gangs, say sources in the area.

Zamadiul is not the only victim of theGoldenHospital, an institution, which has time and again been reported in the media for numerous cases of malpractices.

On August 27, doctors of the hospital apparently gouged out an eye of two-year-old Zahed Ullah. The child’s father, Manzurul Alam, said Zahed had problems with his eye and the doctors there promised to cure him for Tk 9,000.

Manzurul accused Dr Akhter Nehal of gouging out Zahed’s eye because he had failed to arrange the money. Dr Nehal, who claims to be a surgeon at the Dhaka Medical College, said it was necessary because Zahed had cancer in his eye.

‘We can investigate such matters only when there is an instruction from the health ministry,’ said ASM Aminul Mowla, assistant director, medical board and private clinic. Due to weak laws many hospitals get away with rampant irregularities, he said.

Sources in the health directorate admitted that there is no inspection of these hospitals by them.

‘We carry out our inspection only when a hospital applies for licence or when it is renewed.’

‘When the maximum penalty for severe irregularities and faults of the hospitals entail only a fine of Tk 5,000 and six months’ imprisonment, it is extremely difficult to curb such offences,’ said Aminul regretfully.

Further investigation of Golden Hospital revealed that it has no permanent doctors, nurses or medical assistants. A residential building houses the hospital, which cannot claim to be a hospital due to its inadequate space, improper hygiene and dirty toilet facilities.

‘This hospital is not the only one in the trade that is guilty. Our neighbouring hospitals are also involved in similar unethical practice,’ says Akram Hossain, owner ofGoldenHospital.

Inquiry at the health directorate reveals that Golden Hospitals not authorised by the government due to its severe irregularities.

Patients suffer the heat emitted by the kitchen, and the only toilet adjacent to the wardroom spreads the malodour of faeces, disgusting the helpless patients. Moreover, insects wander around in its operation theatre. The surgical equipment and medical accessories used for treatment are rusty, posing the risk of infection and gangrene.

Earlier this year, the hospital was fined Tk 50,000 by a mobile court for not maintaining minimum hygiene standard. However, that did not affect the business of the hospital because it gets patients through brokers.

Victims claimed that doctors did not give them any specific report about their health condition, and they were not even cured after their operations. Moreover most of them suffer infections due to the use of non-immunised surgical equipment.

‘After the doctor on duty checked my blood pressure, he didn’t write it down,’ said Karim Molla, another patient who suffered infection after his treatment.

Four years into its illegal business, the hospital has been continuing its trade without any legal actions against it. Furthermore, whenever aggrieved patients threatened to complain, hospital authorities intimidated them, telling them that they had enough clout to ‘manage’ the journalists and police.

Second officer Giyasuddin of Mohammadpurthanaadmitted that he knew that these hospitals were substandard and were involved in malpractice. ‘However, we cannot take action against them since there are no complaints,’ he said.

Under Section 9 of The Medical Practice and Private Clinics and Laboratories (Regulation) Ordinance, 1982, a hospital can be licensed only if it has proper accommodation with hygienic environment for the patients, at least 80 square feet of floor space for each patient, an air-conditioned operation theatre, a set of 36 essential equipment, adequate supply of life-saving and essential medicines, at least one registered doctor, two nurses and one sweeper for ten beds round the clock, and specialists for operation, treatment and supervision of patients.

However, the penalty under Section 13(1) is a fine of only Tk 5,000 if any registered doctor or owner of a private hospital contravenes the provisions of the ordinance. The court may order forfeiture to the government of any movable property in the laboratory if the owner or practitioner is convicted.

Section 14 of the ordinance recommends that no court shall take cognizance of an offence under this ordinance except on a written complaint by the director-general of health or an officer authorised by him.

Sources inGoldenHospitalalleged that it has good connections with the Mohammadpur police station. Besides, a hefty sum of money is apportioned to the police and the local hoodlums.

Akram’s GoldenHospital, infamous for numerous wrong surgeries, still continues to operate by taking advantage of weak laws and the indifference of the health and home affairs ministries.

A number of patients complained about unqualified and fake doctors performing operations in this hospital. Furthermore, witnesses alleged that the doctors perform multiple surgeries simultaneously.

Lack of evidence that will stand up in court is one of the primary reasons why the police, along with the health directorate, fail to convict owners of these hospitals, said sources in the industry.

‘It requires a concentrated deployment of the law enforcers to nab the culprits in the hospital business, which is not possible without the home ministry’s instruction,’ said a highly placed officer in the Rapid Action Battalion.

‘With each passing day, the home ministry’s ignorance is strengthening an already established criminal network,’ he adds.